What to know about Jaw Surgery

jaw surgery orthodontics

What to know about Jaw Surgery

jaw surgery orthodontics5 Feb 2024 | by Dr. Eric Meyer

What is jaw surgery?

Orthognathic surgery, colloquially known as jaw surgery, is a procedure performed to correct various jaw imbalances and facial irregularities. Common examples include a severe “underbite”, small lower jaw, or very narrow upper jaw. These can result from irregular growth, development, or injuries and may cause issues with biting, chewing, breathing, or speaking. In order to correct these abnormalities, a surgeon will reposition the upper jaw, lower jaw, or both jaws to restore a normal jaw position and provide facial balance. These surgeries may also include the temporomandibular joint (TMJ) for those who experience TMJ dysfunction and pain.

What is the process for jaw surgery?

Typically this treatment requires a pre-surgical phase of orthodontics to align the patient’s teeth before the surgeon performs the operation, most often in a hospital setting under general anesthesia. After the surgery is complete, a recovery phase and short post-surgical phase of orthodontics allows our doctors to fine-tune the patients occlusion and avoid relapse of the post-surgical results. Although, it may be possible with Invisalign®️, braces are almost always the preferred treatment modality for the best possible outcome.

What are the benefits of jaw surgery?

Orthognathic surgery has various benefits depending on the type of surgery performed:

  1. Improved Functionality: Orthognathic surgery can significantly enhance the function of the jaw, allowing for better biting, chewing, and speaking.
  2. Enhanced Facial Aesthetics: The surgery can improve facial balance and harmony, enhancing the patient’s overall facial appearance.
  3. Relief from Pain: For individuals experiencing TMJ pain (temporomandibular joint pain), orthognathic surgery can provide relief depending on the type of surgery, for example, joint replacement surgery.
  4. Correction of obstructive sleep apnea: For individuals diagnosed with severe sleep apnea, orthographic surgery may be recommended to bring one or both of the jaws forward and thereby significantly opening the airway and improving breathing.
  5. Boost in Confidence: Correcting facial asymmetry or other noticeable issues can boost self-esteem and confidence.

What are the risks of jaw surgery?

Like all surgical procedures, orthognathic surgery does not come without risks which may include infection, altered nerve sensation, swelling or bruising, relapse, and limited jaw movement during healing. It is important to discuss the risks of jaw surgery with the operating surgeon beforehand.

What is the cost of jaw surgery?

As you can imagine this surgery may be quite expensive without a medical insurance that covers the procedure. It is dependent on the type of surgery performed and any hospital stay involved, although a hospital stay may not be needed for some procedures. To avoid any financial surprises, verify with your insurance the coverage and any out-of-pocket expenses before proceeding with treatment.

It’s important to note that the decision to undergo orthognathic surgery is typically made after careful evaluation by an orthodontist and oral/maxillofacial surgeon, in coordination with your general dentist. They assess the individual’s specific condition, overall health, and potential risks to determine if the benefits of the surgery outweigh the risks. Patients should discuss any concerns or questions with this team before making a decision.

What are orthodontic expanders?

fixing cross bite with braces orthodontics

Orthodontic Expanders: What They Are, How They Work, and Why You Might Need One

expander to fix cross bite14 January 2024 | Dr. Eric Meyer

What are orthodontic expanders?

Orthodontic expanders are custom-made devices that are used to widen the dental arch and at certain ages widen the jaw. They may be recommended for children and teens who have a narrow palate, a crossbite, crowded teeth, or impacted teeth. Adults may also benefit from expanders, although the process is different due to the stage of development.

How do orthodontic expanders work?

Orthodontic expanders are typically fixed to the first molars and work by applying gentle pressure to the tongue-side of the teeth. The widening process can take anywhere from a few weeks to a few months, depending on the amount of expansion needed. After the desired width is achieved, the expander is left in place for several more months to allow for the new bone to stabilize.

What is the purpose of orthodontic expanders?

Orthodontic expanders have several benefits for the oral health and appearance of the patients:

  1. To correct a crossbite, which is when the upper teeth fit inside the lower teeth instead of outside. A crossbite can cause problems with chewing, speaking, and jaw development.
  1. To prevent or treat crowded teeth, which are when the teeth do not have enough room to fit  properly in the jaw. Crowded teeth can lead to tooth decay, gum disease, and difficulty with cleaning and flossing.
  1. To prevent or treat impacted teeth, which occurs when the teeth are blocked from coming in by other teeth—usually due to a lack of space.
  1. To improve the facial profile and aesthetics, by creating a broader smile. In children and teens a palatal expander widens both the teeth and the upper jaw resulting in a wider smile.  Adults may have the same effect with other types of expansion.
  1. To improve the nasal breathing and airway, by opening up the nasal passages and reducing the risk of snoring, sleep apnea, and other respiratory problems. This, of course, depends on the amount of expansion achieved. It is not uncommon for adults with a cross bite to undergo surgical expansion and potential jaw surgery to correct sleep apnea.
fixing cross bite with braces orthodontics
Before (Posterior Crossbite)
fixing cross bite with braces orthodontics
After (Posterior Crossbite)
What are some common misconceptions about orthodontic expanders?

There are some misunderstandings about orthodontic expanders that may cause some people to hesitate or avoid them:

Myth: Orthodontic expanders are painful and uncomfortable.

Fact: Orthodontic expanders may cause some discomfort and pressure at first, but almost all of our patients get used to them quickly and do not experience significant pain. The discomfort can be relieved by taking over-the-counter painkillers, applying ice packs, and eating soft foods.

Myth: Orthodontic expanders are only for children and teens.

Fact: Orthodontic expanders are most effective and easier to use in children and teens, because their jaws are still growing and flexible. However, adults can also benefit from orthodontic expanders, although they may need more invasive procedures, such as surgically-assisted or implant-supported expanders, to achieve the same results.

Myth: Orthodontic expanders are only for cosmetic purposes.

Fact: Orthodontic expanders are not just for improving the appearance of the smile, but also for improving the function and health of the teeth, jaws, and airway. They can prevent or treat many dental and orthodontic problems that can affect the quality of life and well-being of the patients.

In summary, expanders are valuable tools that can help many patients achieve a healthier and more beautiful smile. They can widen the dental arch and jaw to create more space for the teeth, as well as improve the bite, the facial profile, and the breathing. Orthodontic expanders are safe, effective, and comfortable to use, and they can prevent or reduce the need for more complex and costly treatments in the future. If you think you or your child may benefit from orthodontic expanders, contact us and schedule a consultation. We will evaluate your condition and recommend the best treatment option for you.

Stay warm out there!

-Dr. E

Why your bite is just as important as your smile

bite and smile

why your bite is just as important as your smile

20 October 2023 | By Dr. Eric Meyerbite and smile

When undergoing orthodontics many focus on the smile as the primary outcome, however, we strive for more than just straightening teeth. At Dubuque Orthodontics, we believe the way your teeth come together and function, or “occlusion,” is just as important as having an amazing smile. Of course, a well-aligned smile can positively impact self-esteem and social interactions; however, a good outcome is more than just the smile. Having a good dental bite is crucial for long-term oral health for several reasons:

1. Long-term protection of teeth from unnecessary wear and tear

First and foremost, a proper bite alignment ensures that your teeth meet and function correctly. This reduces the risk of excessive wear and tear on certain teeth, preventing issues like chipping and fractures that occur over time. Something as simple as improving your bite will save you a lot of time and money down the road. Did you know that only 30% of people have a “normal occlusion1”?

2. Reduced risk of periodontal disease affecting the gums and bone supporting your teeth

A large study by Bernhardt et al. (2019) showed that individuals with malocclusions were up to 75% more likely to experience recession and periodontal disease2.

Furthermore, proper dental alignment also contributes to better oral hygiene. Straight teeth are easier to clean and maintain, reducing the risk of gum disease and cavities. When teeth are aligned correctly, there are fewer gaps and overlapping areas where food particles and plaque can accumulate.

3. Better function and chewing efficiency

When it comes to function, a correct bite alignment also promotes effective chewing and digestion. When teeth are aligned properly, much like a zipper comes together, we are able chew food thoroughly. The front teeth tear food, while the back teeth grind food into digestible pieces. Imagine your top teeth and bottom teeth not touching in the front—that makes it a lot more difficult to take a bite!

4. Harmony between your teeth, chewing muscles, and jaw joints

Although evidence does not point to a poor bite being a primary cause of temporomandibular joint disorder (TMD)3, a malocclusion may be a secondary factor in what affects a healthy jaw joint. Primary factors, such as, clenching and grinding, arthritis, neuralgia, or trauma should be identified and managed first. It is important to note that orthodontic treatment may or may not help with TMJ issues.

In summary, a good dental bite ensures proper oral function, reduces the risk of dental problems, and contributes to overall oral health and well-being. A visit to your orthodontist will help you identify and correct problems in your bite, while giving you a straighter smile.

As always, have a great day.

-Dr. E

 

 

  1. Proffit, W R et al. “Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey.” The International journal of adult orthodontics and orthognathic surgery vol. 13,2 (1998): 97-106. https://pubmed.ncbi.nlm.nih.gov/9743642/
  2. Bernhardt, Olaf et al. “New insights in the link between malocclusion and periodontal disease.” Journal of clinical periodontology vol. 46,2 (2019): 144-159. doi:10.1111/jcpe.13062. https://pubmed.ncbi.nlm.nih.gov/30636328/
  3. Okeson, Jeffrey P.. Management of Temporomandibular Disorders and Occlusion: Management of Temporomandibular Disorders and Occlusion – E-Book. United States, Elsevier Health Sciences, 2019.

Teeth Whitening After Braces or Invisalign®

whitening after braces or invisalign

Teeth Whitening After Braces or Invisalign®

whitening after braces or invisalign

25 August 2023 | By Dr. Eric Meyer

After getting your braces removed, you may consider teeth whitening to compliment your great smile and enhance the shade of your teeth.

Here are a few things to consider before starting whitening:

When can I start whitening my teeth?

It is best to wait until braces are removed or the “tooth-colored bumps” with Invisalign® are removed before whitening teeth. This will allow the whitening agent to whiten the entire surface without interference from braces or Invisalign® attachments.

If you are planning on having any dental restorations completed, it is best to coordinate with your dentist and typically whiten teeth prior to any restorative work being done. This will allow your dentist to closely match the restoration to the shade you have settled on after whitening your teeth. 

It can be more difficult to match the shade of your teeth with a restoration the opposite way. This is why it is important to note that if you have existing restorations or crowns, they will NOT change color with whitening. It may not be esthetic when all the teeth are a whiter shade than a few teeth with dental restorations or fillings. In this case you may need those redone or touched up by your restorative dentist.

How long does it take to whiten teeth?

It depends on the amount of whitening desired from the initial shade of your teeth, as well as the method of tooth whitening. For example, in-office whitening takes place over a short appointment, as opposed to at-home whitening, which takes days or weeks to accomplish the desired shade.

How does in-office whitening work?

In-office whitening, involves the application of concentrated whitening gel to your teeth over a short period of time for essentially instant results.

How does at-home whitening work?

At-home whitening typically involves over-the-counter whitening strips or custom whitening trays and gel provided by your dentist. The time of application can be anywhere from one hour to several hours over a night of sleep depending on the concentration of the product. Thus, it is important to follow instructions provided in the kit or by your dentist to achieve the most optimal results safely and comfortably. Although this method is convenient, it may take several applications to achieve the desired result.

Which method is the most effective?

In-office > custom whitening trays and gel > over-the-counter whitening strips

Will my teeth be sensitive during and after whitening?

It is not uncommon for tooth sensitivity to arise from whitening. Before starting you may consider an anti-sensitivity toothpaste to desensitize your teeth prior to starting and continue through the whitening process. For individuals with very sensitive teeth to hot or cold foods and drinks a lower concentration of whitening gel should be considered and discussed with your dentist.

Can I eat and drink anything while whitening my teeth?

To properly whiten teeth we recommend avoiding food or drink that tends to cause staining, including but not limited to coffee or tea, red wine, dark colored fruits and vegetables, and dark condiments or sauces, such as soy sauce. As your teeth renormalize from the process, it is best to avoid these foods for a few weeks after whitening, as well. To minimize future staining consider drinking these beverages through a straw and cleaning your teeth directly after consumption and limiting the time of consumption (i.e. slam that coffee as opposed to sipping throughout the day).

If you are considering whitening your teeth please consult with your dentist or orthodontist first to ensure that it’s suitable for your individual situation!

Have a great day/week!

-Dr. E

Mouth Guards for Sports

mouth guards for braces

Mouth Guards in the Prevention of Sports-Related Injuries

mouth guards for braces
Mouth guards are meant to be worn, not chewed 🙂

It is estimated that players of contact sports have a 28% chance of sustaining an injury to the face or mouth (Oliveira et al.). Although, we hope that never happens to anyone, we aim to reduce the risk of injury if possible.

When it comes to the prevention of oral and dental injuries, mouth guards have been shown to reduce the risk of injury by 50% (Heintz et al.).

What are the types of Mouth Guards?

  • Stock Mouth Guard: these are purchased over-the-counter. They tend to have a looser fit, as they are not custom made.
  • Boil-and-bite: these are purchased over-the-counter. This style has a nice fit if done right and will work for most athletes.
  • Custom-made: these are made by a dental provider. They have the best fit and will be modified to fit not too large or small, but ‘just right’ for your dental arches.

Which Mouth Guard is right for you?

For anyone in active orthodontic treatment, a stock mouth guard provided by your orthodontist is the best way to go. Since your teeth are constantly moving, a custom mouth guard will not fit in a matter of days. Thus, the mouth guard should leave room for the braces and teeth to move to the intended positions. This is true for patients in braces and clear aligners (Invisalign®, Spark®).

For anyone not in orthodontic treatment, a boil-and-bite or custom mouth guard will work best for a nice fit. A custom mouth guard will fit the best and provide the most comfort during  a sporting event or any physical activity.

If you have any questions regarding what mouth guard is best for you or you child don’t hesitate to ask us!

Have a great day/week!

-Dr. E

  1. Oliveira Werlich M, Honnef LR, Silva Bett JV, et al. Prevalence of dentofacial injuries in contact sports players: A systematic review and meta-analysis. Dent Traumatol 2020;36(5):477-88. https://pubmed.ncbi.nlm.nih.gov/32176431/
  2. Clegg JH. Mouth protection for the rugby football player. Br Dent J. 1969 Oct 7;127(7):341-3. PMID: 5259663. https://pubmed.ncbi.nlm.nih.gov/5259663/
  3. Heintz WD. Mouth protectors: a progress report. Bureau of Dental Health Education. J Am Dent Assoc. 1968 Sep;77(3):632-6. doi: 10.14219/jada.archive.1968.0267. PMID: 4385941. https://pubmed.ncbi.nlm.nih.gov/4385941/

Invisalign® for Teens

invisalign for teens

Invisalign® for Teens

invisalign for teens20 July 2023 | By Dr. Eric Meyer

Invisalign® (clear aligners) for teens is a relatively new and popular orthodontic treatment that provides a discreet alternative to traditional braces. As a parent or a teenager considering orthodontic options, you’ll find invisible aligners to be a compelling choice due to its unique benefits and features.

1. Nearly invisible for enhanced esthetics

First and foremost, the clear aligners used in Invisalign are virtually invisible, making them an excellent choice for self-conscious teenagers who may feel uncomfortable wearing traditional metal braces. This aesthetic advantage can significantly boost a teenager’s confidence during the treatment process.

2. Removeable, making oral hygiene easier and fewer diet restrictions

Another significant advantage of Invisalign for teens is its removable nature. The aligners are to be taken out during meals, which means there are essentially no food restrictions as is the case with braces. This allows teenagers to continue enjoying their favorite foods without worrying about damaging brackets or wires. Additionally, proper oral hygiene is more manageable since the aligners can be removed for easy brushing and flossing.

3. Comfort, no wires or brackets!

Invisalign® also offers enhanced comfort compared to traditional braces. The aligners are custom-made to fit the individual’s teeth, and there are no sharp brackets or wires that could cause discomfort or irritation to the cheeks and gums. This is especially beneficial for active teens involved in sports or other physical activities.

4. Not ideal for everyone

It’s important to note that clear aligners may not be suitable for all orthodontic cases. Severe malocclusions or complex tooth movements might still require traditional braces or other orthodontic solutions. For these cases, one might consider clear braces or “tooth colored braces.”

5. Continuous monitoring by your orthodontist

Regular check-ups with the orthodontist are necessary throughout the treatment, typically every six to eight weeks. During these visits, the orthodontist will provide new sets of aligners and monitor progress, making adjustments as needed to ensure the teeth are moving as planned.

6. Compliance is key!

One possible concern with clear aligners is that its success relies heavily on the teen’s compliance. The aligners must be worn for 20-22 hours a day to achieve the desired results. Some teens may forget to wear them consistently, which could prolong the treatment process or compromise the effectiveness of the treatment.

In summary, clear aligners are a very esthetic alternative to braces for teens and adults. If you would like to see if your child is a candidate for invisible aligners please setup a free exam.

As always, have a great day/week!

-Dr. E

What Is The Difference Between Clear Braces and Invisalign (Clear Aligners)?

clear aligners invisalign at dubuque orthodontics

What Is The Difference Between Clear Braces and Invisalign (Clear Aligners)?

If you are looking to straighten your teeth without wearing metal braces there are a few cosmetic alternatives to consider — clear braces or clear aligners (such as Invisalign or Spark). 

Although both options will move your teeth, they differ considerably. Each option has its pros and cons and it’s important to understand them when deciding the best treatment modality for you. We will go through a brief summary of each.

Clear (Cosmetic) Braces

clear cosmetic braces

These come in the same form as metal braces, however, they are made of a plastic or porcelain that matches the shade of your teeth. Since they are the same form they will have a similar ‘feel’ as metal braces with a more esthetic appearance. They will also have a wire that will passes through them as they do with metal braces, so the mechanics of the tooth movement are the same. 

Not all patients aregreat candidates for Invisalign and would prefer a more esthetic option. These cosmetic braces allow us to have the same control of tooth movement that we don’t always have with Invisalign in complex cases.

The process with clear cosmetic braces is the same as with metal braces, meaning we can still treat the most challenging cases and get great results.

Clear Aligners (Invisalign, Spark, DO Aligners, etc.)

invisalign clear alignersThis is an umbrella term for the clear, removable trays that move teeth. These are essentially made from high quality plastic material — meaning no wires and no braces involved!

As the ‘invisible’ aligners are made of a clear material they are virtually unnoticeable to the average person. This makes clear aligners, such as Invisalign or Spark aligners, to be the most esthetic.

The aligners are custom-made to precisely fit your teeth. We program a small amount of tooth movement into each tray to move your teeth little-by-little as you move through the sequence of trays—switching every one to two weeks.

Unfortunately, due to the features of Invisalign we don’t always have the best control of tooth movements. This reduces the predictability when treating more challenging cases.

On occasion, to increase the predictability of moving teeth, we add tooth colored bumps that act as handles for the plastic to move your teeth. These also allow the trays to ‘click’ nicely onto your teeth.

If you are looking for a cosmetic, esthetic alternative to metal braces contact our office to evaluate your options!

-Dr. E

Preventing White Spots with Braces

white spots and braces

Say Goodbye to White Spots: Preventing Dental Decalcification with Braces

white spots and braces

23 June 2023 | By Dr. Eric Meyer

Braces are a common orthodontic treatment that can effectively straighten teeth and create a beautiful, confident smile. While in braces the development of white spots on the teeth can occur with poor oral hygiene habits. These unsightly marks, known as dental decalcification or white spot lesions, occur when the enamel surrounding the braces is damaged by plaque buildup. The good news is that with proper care and attention, you can eliminate the risk of white spots and maintain a healthy, vibrant smile throughout your orthodontic journey. 

Understanding the Causes

White spots are areas of demineralization on the tooth enamel, appearing as opaque or chalky patches. They are primarily caused by poor oral hygiene, which leads to the accumulation of plaque and bacteria around the brackets and wires of braces. The bacteria produce acid as they feed on sugars and food particles, eroding the enamel and leaving behind these noticeable white spots.

Preventing White Spots

While the risk of white spots can be a concern, adopting a proactive approach to oral hygiene can significantly reduce the likelihood of their formation. Here are some essential tips to prevent white spots when wearing braces:

1. Maintain a Thorough Oral Hygiene Routine:

Brushing and flossing regularly are crucial habits to combat plaque buildup. Use a soft-bristled toothbrush and fluoride toothpaste, brushing at least twice a day for two minutes each time. Pay extra attention to the areas around the brackets, wires, and the gum line. Additionally, incorporate daily flossing and rinse with an antimicrobial mouthwash to remove plaque from hard-to-reach places.

2. Choose the Right Tools:

Invest in orthodontic-specific tools to enhance your cleaning routine. Interdental brushes, floss threaders, and water flossers are a great in addition to a good ol’ fashioned tooth brush.

3. Mind Your Diet:

Limit your intake of sugary and acidic foods and beverages, as they contribute to the formation of plaque and increase the risk of enamel erosion. Opt for a balanced that includes vegetables, nuts, and dairy products. among other non-cariogenic foods.

4. Stay Hydrated:

Studies have shown individuals with “dry-mouth” are at a higher risk of tooth decay than those without. Drinking water not only keeps you hydrated but also promotes saliva production. Saliva acts as a natural defense mechanism, neutralizing acid and protecting the teeth from decay.

5. Visit Your Dentist Regularly:

Maintaining regular dental check-ups is crucial during orthodontic treatment. Your dentist will monitor your oral health, professionally clean your teeth, and provide guidance on maintaining excellent oral hygiene.

In conclusion, white spots can be an unwelcome side effect of wearing braces, but with the right knowledge and commitment to oral care, they can be prevented. By implementing a diligent oral hygiene routine, making smart dietary choices, and seeking professional guidance, you can safeguard your teeth from decalcification and ensure that your orthodontic journey is accompanied by a healthy, beautiful smile. Remember, the effort you put into caring for your teeth during braces will pay off with long-lasting oral health benefits and a radiant smile you can be proud of.

As always have a great day and week!

-Dr. E

Do Wisdom Teeth Cause Crowding?

do wisdom teeth cause teeth to shift or crowding

Do Wisdom Teeth Cause Crowding?

do wisdom teeth cause teeth to shift or crowding

25 May 2023 | By Dr. Eric Meyer

Our third molars—if you were unfortunate enough to have them all, like me—were given the name “wisdom teeth” because they are the last teeth to erupt around the age of 17 to 25…when we are supposedly wiser.

We have long been told that our wisdom teeth cause our front teeth to shift or crowd when they come in. The theory is that as these molars erupt they “push” the teeth in front of them, squeezing them into a crowded position. Is this really the case?

A bevy of evidence exists that does not support this theory (see a few, references 2-7 below).

In reality, whether you have third molars or not, the overwhelming majority of evidence finds that overtime crowding is natural and to be expected (we’ll save this for another post). These studies reported there was no significant difference in crowding over time between individuals with and without wisdom teeth.

With that being said, there are plenty of reasons to consider extraction of wisdom teeth, as they may cause much greater problems down the road than crooked teeth, such as pain, infection, and tooth loss related to dental decay and periodontal problems. We often encourage extraction of wisdom teeth that appear to have a poor position or lack of space to erupt.

So how do we prevent any shifting of your teeth from happening?

If you had orthodontics in the past and you want to maintain your straight smile…wear your retainers as long as you can (at least at night)!

As always, have a great week!

-Dr. E

 

 

 

 

  1. Renton T, Wilson NH. Problems with erupting wisdom teeth: signs, symptoms, and management. Br J Gen Pract. 2016;66(649):e606-e608. doi:10.3399/bjgp16X686509
  2. Kaplan, R.G., 1974. Mandibular third molars and postretention crowding. American journal of orthodontics66(4), pp.411-430.
  3. Ades, A.G., Joondeph, D.R., Little, R.M. and Chapko, M.K., 1990. A long-term study of the relationship of third molars to changes in the mandibular dental arch. American Journal of Orthodontics and Dentofacial Orthopedics97(4), pp.323-335.
  4. Bishara, S.E., 1999. Third molars: a dilemma! Or is it?. American Journal of Orthodontics and Dentofacial Orthopedics115(6), pp.628-633.
  5. Okazaki, K., 2010. Relationship between initial crowding and interproximal force during retention phase. Journal of Oral Science52(2), pp.197-201.
  6. Al-Balkhi, K.M., 2004. The effect of different lower third molar conditions on the re-crowding of lower anterior teeth in the absence of tight interproximal contacts one-year post orthodontic treatment: a pilot study. J Contemp Dent Pract5(3), pp.66-73.
  7. Southard, T.E., Southard, K.A. and Weeda, L.W., 1991. Mesial force from unerupted third molars. American Journal of Orthodontics and Dentofacial Orthopedics99(3), pp.220-225.

The Power of Growth Modification in Orthodontics

orthodontics for kids

The Power of Growth Modification in Orthodontics

17 February 2023 | By Dr. Eric Meyer

orthodontics and dentofacial orthopedics

Kids are reflections of their parents. Maybe they have mom’s eyes or dad’s nose. “A chip off the ol’ block”, right? Well, they may have also inherited dad’s underbite or mom’s overbite, in addition to other characteristics.

Genetics play a major role in the growth and development of a child.

That’s not to say growth can’t be modified or influenced by environmental factors, such as orthodontics and dentofacial orthopedics. In orthodontics this would involve therapy to normalize growth and improve imbalances in the position of the upper and lower jaws.

Expanders, for example, increase the width of the upper jaw—perfect for children with constricted upper jaws and side crossbites.

Headgear can effectively correct imbalances in the position of the upper jaw, like restricting or enhancing it’s growth. In a child with deficient growth of the upper jaw, ‘protraction facemask’ (also known as reverse-pull headgear), brings the upper jaw forward and out of an ‘underbite’. This works by opening the sutures of the facial complex as the child is growing, however, the sutures must first be open.

This is why it is crucial to start this therapy at an earlier age before the sutures fuse completely with time.

Is there any evidence to support this type of growth modification? Lots of it! A recent study (Hino et al.)1, using 3D x-rays, showed that on average the upper jaw moved forward 3 mm. In orthodontics every millimeter matters and we will gladly take 3 mm. Imagine if the child is at the right age and compliant—you may be able to double that and save surgical treatment in the future.

I’ll leave you with this example of a child starting with an underbite. This kid corrected his underbite by himself in 9-10 weeks with this appliance!

fixing an underbite at orthodontist
facemask to fix underbite

As always, have great day!

-Dr. E

 

 

  1. Hino CT, Cevidanes LH, Nguyen TT, De Clerck HJ, Franchi L, McNamara JA Jr. Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction. Am J Orthod Dentofacial Orthop. 2013 Nov;144(5):705-14. doi: 10.1016/j.ajodo.2013.07.011. PMID: 24182587; PMCID: PMC3972125.

Gummy Smiles

fixing a gummy smile with orthodontics

What do Gummy smiles and fine wine have in common?

gummy smile orthodontics

17 November 2022 | By Dr. Eric Meyer

What do Gummy smiles and fine wine have in common?

You’ll know the answer shortly. But first how much gingiva is appropriate to show when smiling? Everyone knows the timeless fable of “Goldilocks and the Three Bears.” Not too little, not too much, but juuuuust right. The same goes for the amount of gums you display when smiling. Too much is considered a ‘gummy smile’. None at all makes for an ‘older’ appearing smile. A little bit of gingival display is natural for a kid or young adult and shows youthfulness.

Many factors go into a person’s smile including lip length, lip mobility, tooth length, tooth position, and age to name a few.

Lip Length

A person with shorter lips and thinner lips is more likely to display more of their gums and teeth. How do we fix it? Although soft tissue surgery can be completed to reposition the lips and the muscles controlling the lips, a more conservative option may be lips fillers, especially in patients with thin lips.

Lip mobility

A person with greater mobility of their lips and facial muscles will reveal more gingiva as they raise their lips and contract facial muscles. How do we fix it? Some patients opt for botox, which temporarily relaxes facial muscles and hides a gummy smile.

Tooth length

As teeth erupt the gums should recede showing more of the crown of tooth. For some patients this does not happen, leading to the appearance of shorter crowns. How do we fix it? Expose the entire crown of the tooth with a soft tissue recontouring (gingivectomy) or boney recontouring (crown lengthening).

Face height

This more so relates to the position of your upper jaw when looking from the front. Some individuals have excessive downward growth of their upper jaw. If the lips and soft tissue do not follow it can lead to a gummy smile. How do we fix it? If severe enough, a patient may need jaw surgery to correct the increased vertical growth of the upper jaw. A conservative approach may include moving the teeth upward if surgery is a no-go.

Age

Ever wonder why most elderly people only show their lower teeth when they talk or smile? In reality, the soft tissue of our face will droop downward—for lack of better words—as we get older. You can’t fight gravity! This is why it’s not all that bad to have a gummy smile as a kid or young adult knowing that it will be better as you get older…like a bottle of fine wine!

Concerned about your gummy smile? Come see the smile doctors at Dubuque Orthodontics 🙂

-Dr. E32

Straight talk: What to know about retainers

keeping teeth straight with retainers

Straight Talk: What to know about retainers

keeping teeth straight with retainers

3 October 2022 | By Dr. Eric Meyer

We are now into October, which officially marks the start of spooky season. Sure, those ghosts and goblins set to roam the streets on Halloween are scary, but what’s more scary than finishing orthodontic treatment and seeing your teeth slowly shift back to the original position from lack of retainer wear. Here’s what you need to know about retainers after orthodontics treatment: 

Types of retainers: removable vs. fixed

Removable retainers can be taken in and out and, thus, depend on the patient to wear as directed. These may be clear (Invisalign style) or acrylic/wire (old school). In general, most patients are given clear retainers, although the retainers with the wire resting on front the teeth may be made at the patient’s request or in certain circumstances.

Fixed retainers are a small wire that is bonded to the tongue side of the front teeth. Since these are not removeable they can be difficult to keep clean, but work well in holding those front teeth, especially in cases with severe malalignment or spacing at the beginning of treatment. Occasionally, fixed retainers may break in which teeth can shift if not addressed or even noticed by the patient.

We can make either removable or fixed, but we do prefer removeable in most cases as patients are better able to keep things clean.

Can retainers be worn too long?

No. In fact, we recommend most patients wear their retainers at night for the rest of their lives. We typically start patients on day and nighttime wear then transition to nighttime only.

My teeth have shifted since I completed orthodontics

If you have noticed that your teeth have shifted after some time, don’t sweat it! Contact our office and we will consider options, such as making a new retainer or realigning those teeth that shifted. We offer both clear aligners (Invisalign style) and braces to get you back to where you started.

Keys to Retainers

  • Wear as directed. For retainer wear there is no “one size-fits-all”. Follow your orthodontists instructions to keep your smile straight.
  • Keep them clean. They’ll last longer and stay clearer. A toothbrush and soft soap will do the trick.
  • Handle with care. If it’s not in your face, it’s in your case!
  • Contact us if you lose your retainer or the retainer does not fit. We may be able to adjust them or make new ones.
 
As always, have a great day and enjoy the fall weather!

-Dr. E

Does my child need early orthodontic treatment?

braces for kids

Does my child need early orthodontic treatment?

8 August 2022 | By Dr. Eric Meyer

braces for kidsWhen it comes to early orthodontic treatment, we prefer to wait until a child has lost all of their baby. However, some kids benefit greatly from an early phase of treatment while in the the mixed dentition (typically ages 7-10). This means the child has a glaring issue that can really lead to greater problems down the road if left untreated.

Another term for early treatment is “interceptive orthodontics.” Why, because we want to intercept problems before they turn into headaches. We’ll get to a few examples shortly. 

The American Association of Orthodontists recommends seeing an orthodontist around age 7. This allows an orthodontist to evaluate a child in the early stages of growth and diagnose problems related to growth, tooth development, and tooth eruption, among other things. 

So what do we look for in kids who need an early phase of treatment? Common problems, among others, may include:

Tooth related

  • Side (posterior) crossbite – the top back teeth overlap inside the bottom back teeth
  • Front (anterior crossbite – commonly called an “underbite, where the lower front teeth overlap in front of the upper front teeth
  • Severe crowding and malalignment
  • Excessive spacing, often accompanied by protruding front teeth (that stick out)
  • Space maintenance – when baby teeth are lost prematurely, a small appliance holds the space for us
  • Extra teeth, missing teeth, or impacted teeth
Growth and development related
  • A deficient upper jaw or a strong lower jaw contributing to an underbite
  • A strong upper jaw or deficient lower jaw contributing to excessive space between the top and front teeth
  • Asymmetric growth of the jaws due to crossbites or facial trauma
  • Craniofacial anomalies, such as cleft lip and palate
 
Treating these issues early on and many others will allow for a positive influence on the growth of the child, avoid impaction of teeth, lower the risk of trauma to the front teeth, and in the case of extra or missing teeth, plan for the future. Although a small investment, this early treatment will save you time, money, and unnecessary procedures later on. For more detailed information on early treatment click here to see a description of common problems and how they are solved with early treatment. For a free exam for your child feel free to contact us 🙂


-Dr. E

Oral hygiene during orthodontic treatment

brushing teeth with braces

Oral hygiene during orthodontic treatment

8 September 2022 | By Dr. Eric Meyer

Toothbrush with bracesWhat we love about orthodontics is we have the ability to transform smiles and in doing so improve the lives of our patients. Part of achieving our goal for a healthy, stable, functional, and esthetic smile is good oral hygiene from patients. Although, we deliver the treatment we can’t do it without your help!

As you may have guessed, braces make cleaning your teeth a little more difficult. This is why we want our patients to have excellent brushing and flossing habits. Every patient receives oral hygiene instruction at the start of treatment and continuous feedback on how they are doing with cleaning their teeth throughout treatment.

What we aim to avoid are white spot lesions and cavities during treatment. White spots are the first signs of the weaking of the outer layer of the tooth due to plaque buildup from poor oral hygiene. Plaque loves to accumulate around the brackets and especially at the gumline, making it extremely important to brush all surfaces of your teeth, as well as along the gumlines. White spot lesions are extremely difficult to correct and may even be irreversible if large enough. With continued poor brushing and flossing habits, the white spots eventually turn into cavities, which need to be fixed by your dentist.

Keys to doing your part

  • Continue seeing your dentist every 3-6 months for regular check ups and cleanings.
  • Brush after eating and drinking (unless it is water). If you do not have access to a toothbrush we recommend at least rinsing with water or a mouthrinse. We have travel toothbrushes at our office, so don’t hesitate to ask for one! This or a small bottle of mouthrinse will be very easy to store in a backpack or locker at school. For both toothpaste and mouthrinses, look for Fluoride on the bottle–this ingredient is great for strengthening your teeth and preventing cavities. 
  • Floss after once a day using floss threaders or floss picks made specifically for patients with braces. Another great tool is a Water Pik, a small handheld device in which you direct a stream of water to rinse around the brackets and wires. We highly recommend these for patients with orthodontic appliances that are fixed, such as expanders, pendulums, herbst, and more.
  • Avoid sugary, crunchy, sticky, chewy and hard foods such as caramels, taffy, hard candy, popcorn, pizza crusts, nuts, etc. Eating ice, chewing on pencils or pens and biting into whole apples can cause damage to your appliances. Avoid sugary beverages as if possible and brush or rinse after consumption. 
  • Compliance is key. With your help with appliances, rubberbands, appropriate diets, and taking care of your teeth and gums your treatment will go much quicker!

Lastly, for patients in clear aligner therapy, such as Invisalign, oral hygiene is just as important as with braces. What makes this treatment modality great is that you have the ability to remove the clear trays to easily floss and brush. However, patients must always brush before replacing the trays, otherwise they will trap everything under the trays. As the clear aligners cover every surface of your teeth this is easiest way to get cavities during treatment.

At the end of the day we want you to have a healthy, stable, functional and esthetic smile. However, we don’t want to do that at the cost of destroying teeth with cavities! So do myself and yourself a favor and keep those pearly whites clean before, during, and after treatment! For questions about oral hygiene feel free to come to our office, call us, and visit our resources web page.

-Dr. E

What to know about “black triangles”

fixing black triangles between teeth

What to know about "black triangles"

black triangles between teeth22 August 2022 | By Dr. Eric Meyer

Black triangles, also known as “open gingival embrasures,” are the spaces found below the contacts of adjacent. As the gum tissue does not fill in that space it appears as a dark triangle following the taper of the teeth in contact. These tend to be very annoying, as they are not only unesthetic, but they also trap food. Ever feel like you’re always checking your phone camera to see if you have some food between your teeth? Not fun, right?

What causes black triangles?

To get all “science” on you for a moment, the results of a classic 1992 study by Tarnow et al. showed that “when the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was 6 mm, the papilla was present 56% of the time…” 

What this means is that you have to have a certain height of bone beneath the contact points of adjacent teeth to support the gum tissue. These pesky spaces are the result of inadequate bone levels between teeth. As bone levels fall around teeth the gumline follows which creates the open embrasure we see as a dark triangle. 

The bone level is affected by many things. For example, poor oral hygiene results in poor periodontal health and reduced bone levels. Another example is crowding, or crooked teeth. These teeth generally have lower contact points, that are closer to the bone. When these teeth are straightened the contact points rise, however, the bone level remains the same and a black triangle appears. A reduced periodontium can also be apart of aging. As we get older our bone levels around our teeth may drop and contribute to black triangles.

How do you fix black triangles?

Adding bone between teeth would be the most ideal way, but grafts typically do not lead to a stable results. So, we have to come up with other ways.

  • Restoration by a dentist to build up teeth and “fill in” the black triangle with restorative material.
  • Orthodontics with Interproximal reduction (or filing) between teeth, which drops the contact point and pushes the gum tissue into the black triangle as the result space is closed.
  • Orthodontics to correct the malignment of teeth causing a higher than normal contact point.
  • Injections with hyaluronic acid to increase the volume of the gum tissue, which has found to work only temporarily.
  • Soft tissue gum graft, which is difficult and may not completely resolve the black triangle.
 
In conclusion, black triangles are the result of reduced bone levels relative to the contact point of adjacent teeth. They can often be eliminated or reduced in size by restorative treatment, orthodontics, and periodontics. The best practice is prevention to avoid them with good oral hygiene including brushing and flossing! For more information on addressing black triangles feel free to contact us.
 
-Dr. E

Relapse: Help! My teeth have shifted!

teeth shifted after braces

Relapse: Help! My teeth have shifted!

25 July 2022 | By Dr. Eric Meyerteeth shifted

So you’re finally done with orthodontic treatment. You’ve spent the money and the time for your friendly orthodontist to take off those braces or finish those clear aligner trays. They give you a retainer with a set of instructions and you are the happiest person alive!

Days or months go by and your retainer is gone! Maybe your dog ate it? Perhaps the waiter threw it away with your napkin?

Teeth will shift without retainers

Give it time and your teeth will shift. The degree of relapse will vary from person to person. Some individuals will experience very little shifting, while others significant movement. It’s a matter of stability. My wise professor always told us, “the most stable malocclusion is the initial malocclusion.” What he meant was the greater we deviate from the original alignment of your teeth the less stable the resulting outcome of treatment. Patient’s with very complex malocclusions and extremely difficult cases will need greater consideration after treatment (in general). We may even consider a “fixed” retainer, which is a small wire glued to the tongue side of your teeth in the event you do not wish to have a removeable retainer. Regardless of where you started, you and I would prefer to keep things the way we left them when we finished treatment! 

What are your options now?

Your greatest fear may be going through another short phase of braces, but really this is a great time to consider a few clear aligners to get you back on track. Our retainers just so happen to be “Invisalign” style, clear retainers, so consider these “active” retainers. If you think that your teeth have shifted after orthodontic treatment come see us. We’d be happy to get you back to a straight smile! For more information on treating relapse with clear aligners click here or call us at 563-556-2353

-Dr. E 

Invisalign ®: A clear alternative…

invisalign clear aligners at dubuque orthodontics

Invisalign®: A clear alternative...

18 July 2022 | By Dr. Eric Meyer

invisalign clear aligners at dubuque orthodontics

It’s the year of 2022. 

Self-driving cars are not too far away, Elon Musk is sending re-usable rocket ships into outerspace, and we’re still moving teeth with metal? Not so fast! Align technology launches Invisalign® clear aligners in the late ’90s, howeverrrr, it’s first product is not even close to the efficiency and control that braces offer. Fast forward 20 years and the plastic is much better, the understanding of the force systems are well-studied, and features such as “attachments” (tooth colored bumps that are bonded to teeth) allow for added control. 

So are we there yet? Although it’s come along way, studies have shown that Invisalign still lacks the control that braces offer with certain tooth movements, as well as cases with higher complexity. For example, moving roots is very difficult to do with the plastic trays. This is the kind of tooth movement that would be required in an extraction case where the roots need to move to close extraction spaces. We don’t have to worry about the predictability with wires and brackets. As you already know, braces are stuck to your teeth, so you don’t have a choice. With clear aligners, you are responsible for keeping the clear trays in (for 22 hours each day I might add).

On the other hand, clear aligners allow us to digitally move teeth and even avoid moving certain teeth. For example, if a patient wants to straighten their front teeth and has a great bite in their back teeth we can maintain them that way. That is much harder to do with braces where the outcome is not precisely controlled by a sophisticated computer software and almost all teeth get a bracket. What I really like about clear aligners is the fact that patients can much better floss and brush as they are removeable. 

In summary, braces and clear aligners both have their own pros and cons. Not every patient is a candidate for clear aligners. In patients that are good candidates, Invisalign® works wonderfully. If you have a very complex case don’t worry, though! We can still predictably treat complex cases with a short phase of braces to work out the tough tooth movements, then finish with clear aligners. You get the best of both worlds!

For more information on Invisalgn®, click here, or call our office to schedule a free evaluation!

-Dr. E